Спорные вопросы применения ингибиторов ангиотензинпревращающего фермента и антагонистов рецепторов ангиотензина у пациентов с COVID-19
https://doi.org/10.15829/1728-8800-2020-2580
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Аннотация
Пандемия COVID-19 является серьезной угрозой здоровью и жизни людей во всем мире. Механизм заражения заключается в связывании SARS-CoV-2 с ангиотензинпревращающим ферментом 2 (АПФ2) и интернализации комплекса клеткой-хозяином. Известно, что ингибиторы АПФ (иАПФ)/антагонисты рецепторов ангиотензина (АРА) повышают экспрессию АПФ2 в организме и рекомендованы для лечения многих сердечно-сосудистых заболеваний (ССЗ). Так, было высказано предположение, что лечение блокаторами ренин-ангиотензин-альдостероновой системы (РААС) повышает вирусную нагрузку и риск развития тяжелого острого респираторного дистресс-синдрома. Однако АПФ2 также превращает ангиотензин II в вещества с доказанными кардиопротективными эффектами. Кроме того, предположения о вреде приема ингибиторов РААС на тяжесть COVID-19 не доказаны, в то время как вред отмены иАПФ/АРА при ССЗ научно обоснован, и данных, подтверждающих мнение о том, что введение иАПФ/АРА облегчает проникновение коронавируса путем увеличения экспрессии АПФ2, нет. Согласно рекомендациям Российского кардиологического общества и консенсусному мнению международных кардиологических обществ, необходимо продолжить прием ингибиторов РААС у пациентов с высоким сердечно-сосудистым риском при COVID-19. В настоящем обзоре представлен анализ зарубежных статей, раскрывающих патофизиологические механизмы и рекомендации по применению иАПФ/АРА в лечении ССЗ у пациентов с COVID-19.
Об авторах
О. М. Драпкина
ФГБУ “Национальный медицинский исследовательский центр терапии и профилактической медицины” Минздрава России
Россия
Россия
Драпкина Оксана Михайловна — доктор медицинских наук, профессор, член-корреспондент РАН, руководитель отдела фундаментальных и прикладных аспектов ожирения, директор
Москва
Л. Э. Васильева
ФГБУ “Национальный медицинский исследовательский центр терапии и профилактической медицины” Минздрава России
Россия
Россия
Васильева Любовь Эдуардовна — младший научный сотрудник отдела фундаментальных и прикладных аспектов ожирения
Москва
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Рецензия
Для цитирования:
Драпкина О.М., Васильева Л.Э. Спорные вопросы применения ингибиторов ангиотензинпревращающего фермента и антагонистов рецепторов ангиотензина у пациентов с COVID-19. Кардиоваскулярная терапия и профилактика. 2020;19(3):2580. https://doi.org/10.15829/1728-8800-2020-2580
For citation:
Drapkina O.M., Vasilyeva L.E. Debatable points of using angiotensin-converting enzyme inhibitors and angiotensin receptor antagonists in patients with COVID-19. Cardiovascular Therapy and Prevention. 2020;19(3):2580. (In Russ.) https://doi.org/10.15829/1728-8800-2020-2580
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ISSN 1728-8800 (Print)
ISSN 2619-0125 (Online)
ISSN 2619-0125 (Online)
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